Non-syndromic clefts of the lip and/or palate are among the most common malformations of the head and neck. Hearing loss and otitis media and effusion (OME) are common in cleft palate (CP patients because of poor Eustachian tube (ET) function resulting from hypoplasia and malpositioning of the palatal muscles, hypoelasticity of the ET cartilage and neuromuscular immaturity. One goal of palatal reconstruction is to establish more normal muscle vectors and attachments so as to improve tubal function and prevent future OME episodes. Unfortunately, that goal has not been realized because of a limited knowledge of the anatomical foundation for ET function. Recent methodological advances for evaluating ET function and for in vivo assessment of soft tissue anatomy hold much promise to address that deficiency. In the proposed study, quantitative magnetic resonance imaging (MRI) measurements of the ET and paratubal muscles in combination with measurement of ET function will be used to develop the form-function identity for the ET system in CP patients. Specifically, we will enroll 40 children aged 7-10 years with repaired, unilateral and bilateral complete CP (n+20/group) and with and without tympanostomy tubes for persistent OME (n=10/subgroup). Each child will have an MRI to define ET anatomy and a comprehensive battery of ET function tests to assess function. These data will be compared to those available for non-CP patients and analyzed for consistency with predictions that: 1) compared to age matched non-CP patients. CP patients have a hyperplastic ET cartilage, undeveloped paratubal muscles, aberrant origins and/or insertion for those muscles, greater ET compliance and poorer muscle-assisted ET opening: 2) the relative degrees of poor function and abnormal morphology are graded with the unilateral complete CP patients having lesser deficiencies than the bilateral complete CP patients: 3) the degree of functional impairment in these patients is directly related to the degree of anatomical deficiency, and 4) the anatomical deficiencies noted for CP patients with patent tympanostomy tubes are more extreme than those in the age-matched CP patients without a tympanostomy tube and no recent history of OME. If these predictions are valid, an early MRI study of CP infants be prognostic of the severity and longevity of ME disease and may serve to guide the type of palatal reconstruction for individual patients.